Provider Demographics
NPI:1508265471
Name:HICKEY, KATHARINE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:HICKEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BURLINGTON AVE
Mailing Address - Street 2:UNIT 412
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-5503
Mailing Address - Country:US
Mailing Address - Phone:513-505-5157
Mailing Address - Fax:
Practice Address - Street 1:1111 BURLINGTON AVE
Practice Address - Street 2:UNIT 412
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-5503
Practice Address - Country:US
Practice Address - Phone:513-505-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2014-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012066235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist